09-0606 (RPL)T4ht 4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
--y Date: 6/09/09
Application Number: CZ::�_09-0-0'000606�:� Owner,
Property Address: 792h -VICTORIA DR PEREZCHICA ANTONIO L ; D
APN: 604-343-032-51 -25363 - 1+2.,zo
Application description: POOL - RESIDENTIAL v��p
Property Zoning: LOW DENSITY RESIDENTIAL qu/ TACH 42153
Application valuation: 15000 JUN 15 1�u'
' Contractor: CITY �F i g AU��TA
Applicant: Architect or Engineer. MCRAE POOL & SPAS FINANCEOpfi
79105 DESERT STREAM DR
LA QUINTA, CA 92253
(760)772-2440
Lic. No.: 823017
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury that Iam licensed under provisions of Chapter 9'(commencing with - I hereby affirm under penalty of perjury one of the following declarations: -
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C53 -C27 License No.: 823017 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Dei: ntractar: /�' _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
/ 111 Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER-BUIUDE#bECLARATION insurance carrier and policy number are:
- I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier. EXEMPT Policy Number EXEMPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the - person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I s �lJh those rov.s.onS.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by / .�
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate:'( icon.. —
(_ 1• I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044; Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the - DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or. offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
- one year of completion, the owner -builder will have the burden of proving that he or she did not build or .
improve for the purpose of sale.). - APPLICANT ACKNOWLEDGEMENT -
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. • IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application."
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result of this application, ,
1 _)'I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers,, agents and employees for any act or -omission related to the work being
performed under or following issuance of this permit:
Date: Owner: 2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject -
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - city and county ordinances and state laws relating to building construction, and hereby, authorizer esentatives
of this coun to enter upon the above-mentioned property for inspection ur oses.
Lender's Name:
' D Signatu pplicant or Agent): '
Lender's Address:
LQPERMIT ..
Application Number 09-00000606
•Permit . . BLDG POOL PERMIT
' Additional desc .
Permit Fee . . . . 162.00 Plan Check
Fee
105.30
Issue Date . . Valuation
15000
Expiration Date 12/06/09
Qty Unit Charge. Per
`
Extension
BASE FEE
'45.00
13.00 9.0000 THOU BLDG 2,001-25,000
117.00
Permit .... MECH POOL
Additional desc
Permit Fee 26.00 Plan Check
Fee
.6.50
Issue Date . . . . Valuation
. . .
0
Expiration Date 12106/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.0.0 11.0000 EA MECH FURNACE >100K
----------------------------------------------------------------------------
11.00
Permit . . . ELEC POOL PERMIT-RES
Additional desc .
Permit Fee . . . . 45.00 Plan Check
Fee
11:25
Issue Date Valuation,
0
Expiration Date 12/Q6/09
Qty. Unit Charge Per
Extension
BASE FEE
15.00
1.00 .30.0000 EA ELEC PRIVATE SWIMMING
POOL
30.00
Permit . . . PLUMBING
Additional desc .
Permit Fee 33.00 Plan Check
Fee
8.25
Issue Date .. . . . Valuation
. . .
. 0
Expiration Date . 12/06/09
Qty Unit Charge Per
Extension
BASE FEE
15.00'
2.00 6.0000 EA PLB FIXTURE
12.00
1:00 3.0000 EA PLB .WATER INST/ALT/REP•
3.00
1.00 3:0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00.
Special.Notes and Comments
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
LQPERMIT -
-
Application Number
09-010000606
-
Special Notes and Comments
=
PLACE AT PRE -PLASTER INSPECTION.
EQUIPMENT ENCLOSURE NOT INCLUDED.2007
CODES
Other Fees . . . . ,.
BLDG STDS ADMIN '(SB1473)
1.00
- Fee summary Charged
Paid
Credited
Due
Permit Fee Total 266.00
.00.
.00
266.00
Plan Check Total 131..30
.00
.00
131.30 .
Other Fee Total' 1.00
.00
.00
1,.00
-Grand Total 398.30
.00
.00
398.30
LQPERMIT
CITY OF LA QUINTA�SUB-CONTRACTOR LIST
JOB ADDRESS % 9- .2aQ Vi ClU12i Iii Ln PERMIT NUMBER OWNER Piae2 - cA iG BUILDER .
This form shall be posted'on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved, by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade [ Classification
Contractor
::
Statlx::Contractot..s. License... :.::.:.::.:.;:;
,....: ...:::..:.
Workecs.Gorii ensation;lnswande ° ": ;::...::::::.::
.: .City Busie s
license:;::.:::
:
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
G
42.3ELLeZ
Sf
-.1- p.
3
3) - c�
CONCRETE (C-8.)'.::
FRAMING '(C-5)
STRUCT..STEEL tG-51}
1
-
MASONRY (C-29)
AV
%
`
do./
3a
Vn'
PLUMBING (C-.36)
{ /
G"
LATH; PLASTER (C=35)G
-
E D 7112
/031-0
- �- 1U
Y 2 Z
-31-O
DRYWALL (C-9)
HVAC. (E7201':.::;
ELECTRICAL. (C�10) :. .',
/il `k
em
-
i
ROOFING'.(C.=391;::.:.<::':'' ;
:..
2
SHEET.METAL
GLAZING (C-17):
INSULATION`(C-2i
SEWAGE DISK (6-42)-
PAINTING (C=33)
CERAMIC TILE (C-54)
CABINETS (C-6) ,
FENCING (C713)
d
c
$086
•moi
o3
�!^off'
POOL (C-53) .
sv" & 00-I"Is-mr,
7ft-411n-24,40
Ift -C 62-3011.1
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DRAWN
CHECKED
DATE
17
-23- 5
SCALE
I xtsA-
JOB NO.
SHEET
OF SHEETS
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
��
0Q'
Project Address:' _77- �
I�
Owner's Name: TSH C
A. P. Numbers. quivijA •
c+
Address: -220 G
Legal Description:
Contractor: M c,
Address: DE -Sep
-I S
City, ST, Zip:L13 Qji�yTft C
Telephone: `] -
Project Description: Pool CDN
City, ST, Zip: LA Q 1 47JA
3
Telephone:
.
State Lic. # 8,2 30 1 -7
Arch., Engr., Designer:
City Lic. #:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State-Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Name of Contact Person:E
Telephone # of Contact Person:
- 3 3
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up.
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
I
Plans resubmitted
Grading
IN HOUSE:-
' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees